Power-injectable peripherally inserted central catheters: a step-down access or a real alternative to standard central venous lines?
Critical Care
Power-injectable peripherally inserted central catheters: a step-down access or a real alternative to standard central venous lines?
Fernando Godinho Zampieri 0
0 Intensive Care Unit, Rua Dr. Eneas de Carvalho Aguiar 255, Fifth Floor, Emergency Medicine Discipline, Hospital das Clinicas, University of Sao Paulo , Sao Paulo , Brazil
-
The recent article by Pittiruti and colleagues reports
important clinical experience with power-injectable
peripherally inserted central catheters (P-PICCs) in critically
ill patients [1]. Nevertheless, I believe some of the
findings deserve clarification.
The authors argue that an advantage of P-PICCs is the
possibility to deliver a faster infusion of fluids and/or
drugs to critically ill patients. Since P-PICCs were not
inserted during emergencies and in severe sepsis,
however, the benefit of allowing high flow rates is limited
to patients that develop haemodynamic distress after
catheter placement. The advantage of allowing infusion
of contrast media, although important, is no different
from other peripheral noncentral venous devices.
To help understand the role of P-PICCs and to compare
complication rates with standard central lines (central
venous catheters), it would therefore be interesting to
Authors response
Mauro Pittiruti and Giancarlo Scoppettuolo
As our study was not a comparative study of the PICC
versus the central venous catheter but a pilot
retrospective study about the clinical performance of P-PICCs
in the ICU, we do not have data comparing the severity of
illness between the PICC group and the rest of the
patients [1].
Reviewing our population data, however, we found that
in most cases both in adults and in children PICCs
were inserted in the first 48 hours after admission to the
ICU (although never as an emergency or in the first 6
hours after admission). In this phase, clinical conditions
know the severity of illness of patients that eventually
received P-PICCs and the percentage of patients that had
P-PICCs as their solo central line during their ICU stay.
The time interval between admission to the ICU and
P-PICC placement would also be interesting data, since
the high dwell time reported by the authors suggests that
P-PICCs were probably preferentially inserted in patients
with prolonged critical illness. If most P-PICCs were
inserted in stable chronic patients, the advantage of
P-PICCs over conventional peripherally inserted central
catheters (PICCs) would be limited in real-life clinical
practice.
In addition to comparing P-PICCs with central venous
catheters, as suggested by the authors, perhaps further
research should also focus on evaluating the role of the
P-PICC as a step-down vascular access for stable
critically ill patients.
may not be completely stable and a sudden need for rapid
volume replacement may still occur, so the presence of a
central line apt to accept high-flow infusion is reassuring.
On reviewing our data we also found that most adult
patients who had a PICC also received other types of
central lines (such as dialysis catheters or central venous
catheters) during their stay in the ICU. In the majority of
paediatric patients and in 30% of adult patients, the
choice of a P-PICC was related to the need for a reliable,
safe line for power injection of contrast medium,
considering that in many patients (particularly in
children) peripheral veins for insertion of a short cannula
of appropriate calibre for contrast injection were not
available.
These data suggest indirectly that, in our ICU, P-PICCs
were not used as an emergency central line but also
were not used as a step-down access.
Competing interests
The authors declare that they have no competing interests.
1. Pittiruti M , Brutti A , Celentano D , Pomponi M , Biasucci DG , Annetta MG , Scoppettuolo G : Clinical experience with power injectable peripherally inserted central catheters in intensive care patients . Crit Care 2012 , 16 : R21 . (...truncated)